| NPI | 1871768762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 6080) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MA 6080) |
| 103TS0200X Psychologist School (Licence: MA 148854) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |